Associate Director Revenue Integrity

About This Role

This position provides operational oversight of the Revenue Integrity Analyst team, focusing on revenue optimization through charge capture reconciliation, review, and education, ensuring compliance with regulatory agencies. The role involves developing team members, implementing process changes, and troubleshooting issues from various stakeholders.

Responsibilities

• Monitor and trend financial data toward revenue cycle goals, identify variances, and implement process improvements to enhance compliant revenue optimization
• Provide operational oversight of revenue integrity staff and serve as a liaison between Revenue Integrity and clinical/operational departments
• Develop, educate, and manage Revenue Integrity Specialists, supporting them in analyzing and communicating deficient charging trends
• Engage with clinical areas and revenue cycle departments to confirm billable items and services are charged appropriately and in a timely manner
• Provide revenue integrity recommendations and updates to the Revenue Integrity Steering Committee and confirm appropriate actions are carried out
• Maintain current knowledge of regulatory changes impacting charge practices and develop charge capture and reconciliation policies and procedures
• Implement charge capture review program for hospital revenue generating departments, coordinating processes to ensure proper documentation, coding, and billing
• Manage charge reviews to incorporate annual coding changes/new service lines into charge master and identify potential compliance and revenue leakage issues
• Work independently under limited supervision, making independent judgments based on specialized knowledge and holding system-wide responsibility for managing charge capture, reconciliation, and chart reviews

Requirements

• Bachelor's degree in business, healthcare administration or equivalent work experience
• 5+ years recent experience in Revenue Integrity
• 2+ years of experience within a leadership role, including performance management of direct reports
• 5+ years of health care coding and billing experience
• Thorough knowledge of ICD/DRG coding and/or CPT coding principles and AHIMA coding competencies
• In-depth knowledge of medical terminology, anatomy and physiology
• Extensive knowledge of all coding conventions and reimbursement guidelines, across all services lines, LCD/NCDs and MAC/FIs

Qualifications

• Bachelor's degree in business, healthcare administration or equivalent work experience
• 5+ years recent experience in Revenue Integrity; 2+ years of experience in a leadership role, including performance management of direct reports; 5+ years of health care coding and billing experience.

Nice to Have

• Additional related education and/or experience

Benefits

Certifications